2016 LOUISIANA RESIDENT - 2D Name Change Taxpayer SSN
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{SCH f} Social Security Number SCHEDULE J – 2016 NONREFUNDABLE PRIORITY 3 CREDITS Nonrefundable Child Care Credits 1 FEDERAL CHILD CARE CREDIT 1 2 2016 LOUISIANA NONREFUNDABLE CHILD CARE CREDIT 2 3 AMOUNT OF LOUISIANA NONREFUNDABLE CHILD CARE CREDIT CARRIED FORWARD FROM 2012 THROUGH 2015 3 4 2016 LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT 4 5 4 3 2 AMOUNT OF LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT CARRIED FORWARD FROM 2012 THROUGH 5 5 2015 Additional Nonrefundable Priority 3 Credits Enter credit description and associated code, along with the dollar amount of credit claimed. Credit Description Credit Code Amount of Credit Claimed 6 6 7 7 8 8 9 9 10 10 11 11 61740 Social Security Number SCHEDULE J – 2016 NONREFUNDABLE PRIORITY 3 CREDITS ...continued Transferable, Nonrefundable Priority 3 Credits Enter credit description and associated code, along with the dollar amount of credit claimed and the State Certification Number from Form R-6135. Credit Description Credit Code Amount of Credit Claimed 12 12 12A 13 13 13A 14 14 14A 15 15 15A TOTAL NONREFUNDABLE PRIORITY 3 CREDITS – Add Lines 2 through 15. Also, enter 16 this amount on Form 540-2D, Line 23. 16 61741 2016 Louisiana School Expense Deduction Worksheet (For use with Form IT-540-2D) Your Name Your Social Security Number I. This worksheet should be used to calculate the three School Expense Deductions listed below. Refer to Revenue Information Bulletin 12-008 and 09-019 on LDR’s website. 1. Elementary and Secondary School Tuition – R.S. 47:297.10 provides a deduction for amounts paid during the tax year for tuition and fees required for your dependent child’s enrollment in a nonpublic elementary or secondary school that complies with the criteria set forth in Brumfield v. Dodd and Section 501(c)(3) of the Internal Revenue Code or to any public elementary or secondary laboratory school that is operated by a public college or university. The school can verify that it complies with the criteria. The deduction is equal to the actual amount of tuition and fees paid per dependent, limited to $5,000. The tuition and fees that can be deducted include amounts paid for tuition, fees, uniforms, textbooks and other supplies required by the school. 2. Educational Expenses for Home-Schooled Children – R.S. 47:297.11 provides a deduction for educational expenses paid during the tax year for home-schooling your dependent child. In order to qualify for the deduction, you must be approved by the State Board of Elementary and Secondary Education (BESE) for home-schooling. The deduction is equal to 50 percent of the actual qualified educational expenses paid for the home-schooling per dependent, limited to $5,000. Qualified educational expenses include amounts paid for the purchase of textbooks and curricula necessary for home-schooling. 3. Educational Expenses for a Quality Public Education – R.S. 47:297.12 provides a deduction for the fees or other amounts paid during the tax year for a quality education of a dependent child enrolled in a public elementary or secondary school, including Louisiana Department of Education approved charter schools. The deduction is equal to 50 percent of the amounts paid per dependent, limited to $5,000. The amounts that can be deducted include amounts paid for uniforms, textbooks and other supplies required by the school. II. On the chart below, list the name of each qualifying dependent and the name of the school the student attends. If the student is home-schooled, enter “home-schooled.” Enter an “X” in the box in column 1 if your dependent qualifies for the Elementary and Secondary School Tuition deduction, column 2 for Educational Expenses for Home-Schooled Children deduction, or column 3 for Quality Public Education deduction. If you have more than six qualifying dependents, attach a statement to your return with the required information. Deduction as described Student Name of Qualifying Dependent Name of School in Section I 1 2 3 A B C D E F III. Using the letters that correspond to each qualifying dependent listed in Section II, list the amount paid per student for each qualifying expense. For students attending a qualifying school, the expense must be for an item required by the school. Refer to the information in Section I to determine which expenses qualify for the deduction. Retain copies of cancelled checks, receipts and other documentation in order to support the amount of qualifying expenses. If you checked column 1 in Section II, skip the 50% calculation below; however, the deduction is still limited to $5,000. List the amount paid for each student as listed in Section II. Qualifying Expense A B C D E F Tuition and Fees School Uniforms Textbooks, or Other Instructional Materials Supplies Total (add amounts in each column) If column 2 or 3 in Section II was checked, 50% 50% 50% 50% 50% 50% multiply by: Deduction per Student – Enter the result or $5,000 whichever is less. IV. Total the Deduction per Student in Section III, based on the deduction for which the students qualified as marked in boxes 1, 2, or 3 in Section II. Enter the Elementary and Secondary School Tuition Deduction here and on IT-540-2D, Schedule E, code 17E. $ Enter the Educational Expenses for Home-Schooled Children Deduction here and on IT-540-2D, Schedule E, code 18E. $ Enter the Educational Expenses for a Quality Public Education Deduction here and on IT-540-2D, Schedule E, code 19E. $ 61708 2016 Louisiana Refundable Child Care Credit Worksheet (For use with Form IT-540-2D) Your Name Social Security Number Your Federal Adjusted Gross Income must be $25,000 or less in order to complete this form. 1. Care Provider Information Schedule – Complete columns A through D for each person or organization that provided care to your child. You may use Federal Form W-10, supplied by your provider, to obtain the information. If your care provider does not provide a Federal Form W-10, complete those parts of the Care Provider Information Schedule for which you have the information. You must follow the same rules of “Due Diligence” as the IRS requires if you do not have all of the care provider information. See IRS 2016 Publication 503 for information on “Due Diligence.” If additional lines are required for Lines 1 or 2, attach a schedule. Falsification of any information provided on this form constitutes fraud and can result in criminal penalties. Care Provider Information Schedule A B C D Address (number, street, apartment Identifying number Amount paid Care provider’s name number, city, state, and ZIP) (SSN or EIN) (See instructions.) .00 .00 .00 .00 .00 2. For each child under age 13, enter their name in column E, their Social Security Number in column F, and the amount of Qualified Expenses you incurred and paid in 2016 in column G. E F G Qualified expenses you Qualifying person’s name Qualifying person’s incurred and paid in 2016 for Social Security Number First Last the person listed in column (E) .00 .00 .00 .00 .00 Add the amounts in column G, Line 2. Do not enter more than $3,000 for one qualifying person or 3 3 $6,000 for two or more persons. Enter this amount here and on Form IT-540-2D, Line 15A. .00 4 Enter your earned income. 4 .00 If married filing jointly, enter your spouse’s earned income (if your spouse was a student or was 5 5 disabled, see IRS Publication 503). All other filing statuses, enter the amount from Line 4. .00 6 Enter the smallest of Lines 3, 4, or 5. Enter this amount on Form IT-540-2D, Line 15B. 6 .00 7 Enter your Federal Adjusted Gross Income from Form IT-540-2D, Line 7, or Schedule E, Line 1, if filed. 7 .00 Enter on Line 8 the decimal amount shown below that applies to the amount on Line 7. If Line 7 is: over but not over decimal amount $0 $15,000 .35 8 $15,000 $17,000 .34 8 X . _______ $17,000 $19,000 .33 $19,000 $21,000 .32 $21,000 $23,000 .31 $23,000 $25,000 .30 9 Multiply Line 6 by the decimal amount on Line 8. 9 .00 10 Multiply Line 9 by 50 percent and enter this amount on Line 11. 10 X .50 11 Enter this amount on Form IT-540-2D, Line 15. 11 .00 61713 2016 Louisiana Refundable School Readiness Credit Worksheet (For use with Form IT-540-2D) Your Name Social Security Number R.S. 47:6104 provides a School Readiness Credit in addition to the credit for child care expenses as provided under R.S. 47:297.4. To qualify for this credit, the taxpayer must have Federal Adjusted Gross Income of $25,000 or less and must have incurred child care expenses for a qualified depen- dent under age six who attended a child care facility that is participating in the Quality Start Rating program administered by the Louisiana Department of Education. The qualifying child care facility must have provided the taxpayer with Form R-10614 which verifies the facility’s name, the state license number, the LA Revenue Account number, the Star Rating, and the rating award date. Complete this worksheet only if you claimed a Louisiana Refundable Child Care Credit on Form IT 540-2D, Line 15. 1. Enter the amount of 2016 Louisiana Refundable Child Care Credit on the Louisiana Refundable Child Care Credit Worksheet, Line 11 . .1 . 00 Using the Star Rating of the child care facility that your qualified dependent attended during 2016, shown on Form R-10614, determine the applicable percentage for the School Readiness Credit from the chart shown below: A Quality Rating B Percentages for Star Rating Five Star 200% (2.0) Four Star 150% (1.5) Three Star 100% (1.0) Two Star 50% (.50) One Star 0% (.00) 2.